Controller interface for an implantable stimulator device

ABSTRACT

Some computer-assisted methods include: presenting configuration options to a user of the implanted stimulator device, the configuration options comprising stimulation parameters for the implanted stimulator; receiving a user specification of the configuration options in response to the presented configuration options; receiving user feedback when the user specified configuration options are implemented at the implanted stimulator device, the user feedback comprising a quantitative index of pain resulting from implementing the user specified configuration options on the implanted stimulator device; building a user profile for the user based on the user specified configuration options and the user feedback, the user profile including the user specified configuration options as well as the corresponding quantitative index of pain; and selecting at least one configuration option based on the user profile when the configuration options are subsequently presented to the user for a later treatment.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority of U.S. ProvisionalPatent Application No. 62/084,743, which was filed on Nov. 26, 2014. Thecontents of the foregoing U.S. provisional application is incorporatedby reference herein in its entirety.

TECHNICAL FIELD

This application relates generally to implantable stimulator devices.

BACKGROUND

Active implanted stimulation devices have been utilized for bothsubcutaneous treatments as well as deeper applications such as pacing,defibrillation, spinal and gastric stimulation.

SUMMARY

In one aspect, some implementations provide a computer-assisted methodto configure settings on an implanted stimulator device. The methodincludes: presenting configuration options to a user of the implantedstimulator device, the configuration options including stimulationparameters for the implanted stimulator; receiving a user specificationof the configuration options in response to the presented configurationoptions; receiving user feedback when the user specified configurationoptions are implemented at the implanted stimulator device, the userfeedback including a quantitative index of pain resulting fromimplementing the user specified configuration options on the implantedstimulator device; building a user profile for the user based on theuser specified configuration options and the user feedback, the userprofile including the user specified configuration options as well asthe corresponding quantitative index of pain; and selecting at least oneconfiguration option based on the user profile when the configurationoptions are subsequently presented to the user for a later treatment.

Implementations may include one or more of the following features.

The stimulation parameters may include polarity setting such thatpresenting configuration options to the user of the implanted stimulatordevice includes presenting configuration options that include a polaritysetting of each electrode of the implanted stimulator device. Building auser profile for the user includes building a user profile that includesthe polarity setting of each electrode that gives rise to thecorresponding quantitative index of pain. Selecting at least oneconfiguration option may include selecting a polarity setting for atleast one of the electrodes of the implanted stimulator device.

The stimulation parameters may include pulse rate, pulse width, andpulse amplitude such that presenting configuration options includespresenting configuration options that that include pulse rate, pulsewidth, and pulse amplitude. The method may further include, in responseto determining that the quantitative index of pain is above a thresholdlevel, prompting the user to change the configuration options. Promptingthe user to change the configuration options may include presenting atleast one configuration option based on the user profile. The method mayfurther include: increasing, by an amount that is proportional to thequantitative index of pain, a pulse amplitude of stimulation pulses forapplication at a particular electrode. The method may further include:in response to determining that the quantitative index of pain is belowa threshold level, prompting the user to reduce stimulation. Promptingthe user to reduce stimulation may include prompting the user to reducestimulation by decreasing a pulse amplitude of stimulation pulses forapplication at a particular electrode. Presenting configuration optionsmay further include cycling through the each configuration optionsubject to user adjustment, the configuration options including apolarity setting of each electrode of the implanted stimulator device aswell as pulse parameters of stimulation pulses for application at aparticular electrode.

Building a user profile may further include recording an adjustment in aconfiguration option made by the user that results in an improvedquantitative index of pain. Recording the adjustment in theconfiguration option may include recording an adjustment in a pulseparameter or a polarity setting.

Some implementations provide a controller device to configure settingson an implanted stimulator device. The controller device includes aprocessor configured to perform the operations of: presentingconfiguration options to a user of the implanted stimulator device, theconfiguration options including stimulation parameters for the implantedstimulator; receiving a user specification of the configuration optionsin response to the presented configuration options; receiving userfeedback when the user specified configuration options are implementedat the implanted stimulator device, the user feedback including aquantitative index of pain resulting from implementing the userspecified configuration options on the implanted stimulator device;building a user profile for the user based on the user specifiedconfiguration options and the user feedback, the user profile includingthe user specified configuration options as well as the correspondingquantitative index of pain; and selecting at least one configurationoption based on the user profile when the configuration options aresubsequently presented to the user for a later treatment.

Implementations may include one or more of the following features.

The stimulation parameters may include polarity setting such thatpresenting configuration options to the user of the implanted stimulatordevice includes presenting configuration options that include a polaritysetting of each electrode of the implanted stimulator device. Building auser profile for the user may include building a user profile thatincludes the polarity setting of each electrode that gives rise to thecorresponding quantitative index of pain. Selecting at least oneconfiguration option may further include selecting a polarity settingfor at least one of the electrodes of the implanted stimulator device.

The stimulation parameters include pulse rate, pulse width, and pulseamplitude such that presenting configuration options includes presentingconfiguration options that that include pulse rate, pulse width, andpulse amplitude. The operations may further include: in response todetermining that the quantitative index of pain is above a thresholdlevel, prompting the user to change the configuration options. Theoperations may further include: further including in response todetermining that the quantitative index of pain is below a thresholdlevel, prompting the user to reduce stimulation.

The details of one or more implementations are set forth in theaccompanying drawings and the description below. Other features,objects, and advantages will be apparent from the description anddrawings, and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a flow chart of an example of a process for interacting withan implanted stimulator device.

FIG. 2A through 2F are illustrations of examples of user interfaces.

FIG. 3 is a flow chart of a process to configure stimulation settings ofthe implanted simulator device.

FIGS. 4A and 4B show example software decision trees to auto-adjusttherapy settings based on recorded pain.

FIGS. 5A and 5B are detailed diagrams of an example of a wireless neuralstimulation system.

Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION

In various implementations, systems and methods allow a user toconfigure stimulation settings of an implanted stimulation devicewirelessly powered by an external controller device. Notably, theimplanted stimulator device does not include a battery or inductivecoupling. Instead, the implanted stimulator device contains thecircuitry necessary to receive the pulse instructions from the externalcontroller outside the body. For example, various implementations employinternal dipole (or other) antenna configuration(s) to receive RF powerthrough electrical radiative coupling. This allows such devices toproduce electrical currents capable of stimulating nerve bundles withouta physical connection to an implantable pulse generator (IPG) or use ofan inductive coil. Moreover, the implanted stimulator device includesone or more electrodes and one or more conductive antennas (for example,dipole or patch antennas), and internal circuitry for frequency waveformand electrical energy rectification. In some implementations, thepolarity of the electrodes (or each electrode pair) of the implantedstimulator device can be configured at a controller device, along withother simulation parameters such as waveform, duration, pulse width, andpulse repetition rate. Further descriptions of exemplary wirelesssystems for providing neural stimulation to a patient can be found incommonly-assigned, co-pending published PCT applicationsPCT/US2012/23029 filed Jan. 28, 2011, PCT/US2012/32200 filed Apr. 11,2011, PCT/US2012/48903, filed Jan. 28, 2011, PCT/US2012/50633, filedAug. 12, 2011 and PCT/US2012/55746, filed Sep. 15, 2011, the completedisclosures of which are incorporated by reference.

In these implementations, a user interface is provided for the externalcontroller device to register an implanted stimulator device. The userinterface also allows a patient to configure stimulation settings to beeffectuated on the implantable stimulator device. The stimulationsettings include polarity settings at each electrode and pulseparameters for the stimulating current. In particular, someimplementations collect user feedback reflecting pain relief resultingfrom various combination of stimulation parameters. Such feedback may beassembled to build a knowledge database, like an expert system. Theknowledge database may be subsequently leveraged to guide the patient,or other patients, in configuring stimulation parameters including, forexample, the polarity settings at each electrode or electrode pair.

In some cases, a software application may incorporate a unique learningengine which uses the history of stimulation parameter adjustments madeby the patient and resulting patient reported pain level scores todetermine a combination of future parameter settings that can be used toprovide improved pain relief for which the patient may prefer based onhis/her historical usage patterns and positions. In some instances, thestimulation parameters include, for example, pulse current, pulse width,pulse rate, dosage time, and electrode polarity patterns.

By way of illustration, the learning engine may determine recommendedstimulation parameter settings based on variables such as patient age,patient gender, target nerve, depth of implantation, type of implantedstimulator devices, anatomic position, duration of therapy, time of day,prior stimulation parameter settings (for example, prior pulse current,pulse amplitude (or transmit power), pulse width, pulse rate, orelectrode polarity), and/or patient pain levels corresponding to priorstimulation parameters. For example, each time after an adjustment ofparameters, the user can record his/her level of pain using a numericpain intensity scale presented by the software application. Based on therecorded pain level and corresponding parameter adjustments, as well asother variables such as those described above, the learning engine maybuild a profile including the combination of parameters that gives riseto improved therapeutic pain relief. The learning engine may then beapplied in various approaches. In one implementation, after the user hasbuilt up history for their profile, the software application may proceedto offer an “Auto” mode on the front page of the Configure tab that canenable the user to actively change the stimulation parameters. Inanother implementation, after the user records his/her present painrating on the numeric pain intensity scale, the application offers toautomate setting a parameter or parameters which are calculated byleveraging historical user input. In yet another implementation, a“Build Your Stim Profile” section of the software application may enablethe user to rank the effectiveness of therapy through visual analogscale, numeric pain intensity scale, or binary (yes or no). While in the“Build Your Stim Profile” mode, the software application may begin tocycle through calculated settings and learn the user's preferences. Inthis cycling process, the application can build a profile more quickly.The feature of the learning engine and its automated parameter selectioncriteria can offer the user a simplified form of interaction which canbe daunting when juggling the many variables involved with stimulationparameters.

FIG. 1 is a flow chart 100 of an example of a process for a user tointeract with an implanted stimulator device. The process may beimplemented by software installed on an external controller device indirect or indirect communication with an implantable stimulator device.Example external controller devices can include a portable computingdevice, such as a tablet, a handheld device, or a laptop device. In someimplementations, the external controller device has its own powersupply, for example, a battery pack. The external controller device maybe separate from or part of a microwave field stimulator (MFS) that isin communication with and providing power to the implantable stimulatordevice. If the external controller is separate from the MFS, theexternal controller may communicate with the MFS during operation suchthat the MFS is programmed according to the instructions from the mobilecomputing device. The communication may be in the form of a cabledcommunication (e.g., USB connection) or a wireless communication (e.g.,based on Bluetooth and IEEE 801.11).

As shown in flow chart 100, a logo is displayed to identify theapplication program invoked (102). An example logo display 202 is shownin FIG. 2A. The logo may be displayed along with a background image 204.This example further shows a login window 206 as a mechanism to enforceaccess control.

Returning to FIG. 1, in one instance, a user enters a valid user nameand password before the user can login (104) to access the controllerand configure the stimulation parameters. In this instance, the loginattempt is first authenticated to determine success (106). If the loginattempt is not successful, the flow will proceed back to display thelogin window. If the login attempt is successful, the process willproceed to display a microwave field stimulator (MFS) selection view(108) and grant access to database 101. Database 101 may includeencrypted data encoding past stimulation parameters and patientfeedback. In other words, only registered user with a valid passwordentry may obtain access in order to configure the stimulationparameters. Thus, such access control enforces security features ofconfiguring stimulation parameters are tailored to a particular patient.

In some implementations, additional system level checks may be performedbefore the user may configure stimulation parameters. In one instance, adetermination is made regarding whether a microwave field stimulator(MFS) is connected to an implanted stimulator device (112). The workflow may proceed when the MFS is in communication with an implantedstimulator. In some cases, the MFS is wirelessly connected to theimplanted stimulator through electrical radiative coupling (e.g.,through the electromagnetic midfield) and not inductive coupling. If theMFS is connected to an implanted stimulator device, anotherdetermination is made regarding whether the connected stimulator deviceis in the database 101 containing recorded stimulation parameters (114).If the connected stimulator device is not in the database 101, the workflow may then proceed to capture patient/device information and registerthe captured information in the database. In some instances, adetermination is made regarding whether the controller is operating in ademo mode (110). For context, demo mode allows the software to showcasethe features and controls available to the user without effectuatingsuch features on the physical MFS unit itself.

After successful login and verifications, a TabView may be displayed insome implantations (118). The TabView may allow a user to choose a view(120). Some implementations may provide five views, namely, patient view122, configure view 124, map view 126, program view 128, and tools view130. In one implementation, the default mode is the patient view 122. Inanother implementation, the chosen view is the configure view 124 bydefault.

Referring to FIG. 2B, an example user interface 210 is displayed forpatient view 122. Through search panel 212, a user may look for aparticular patient's profile in the database. Generally, patient profileinformation 214 is only accessible to authorized users such as thepatient himself/herself, his/her attending physician, his/her appointednurse or caregiver. Such profile information may also be anonymized topreserve patient privacy information. For example, in some instances,only a patient ID is displayed. In these instances, patient profileinformation may include wearable antenna assembly (WAA) signal/noise(S/N), link status, battery status, transmit power status, pulse rate,pulse width, pulse pattern, duty cycle, current amplitude for eachchannel of the each implanted stimulator. Such profile information maycorrespond to the profile information as last accessed. In someinstances, the WAA can be an MFS device. In some instances, the WAA maybe a relay module that bridges signal transmission between an MFS and animplanted stimulator device. When configured as a relay module, the WAAmay include a battery or other power source. The WAA may also be apassive device without an on-board battery or other power source.Generally, such profile information varies from patient to patient. Tab216 may allow an additional patient to be added to the database. Tab 218may allow the logged-in user to log out.

FIG. 2C is an example user interface 220 for the configure view 124,which allows a user to configure the stimulation parameters for theimplanted stimulator device. In this illustration, the top panel of userinterface 220 includes the same logout tab 218 and patient profileinformation 214. The top panel may also include connect button 221 toestablish a wireless connection with an implanted stimulator device.

As illustrated, the central panel enables a user to configure thepolarity and current for each electrode of the implanted stimulatordevice. A user may tap an electrode icon on electrode arrays 222A and222B to initiate adjustment of a polarity setting of correspondingelectrode. The polarity setting on each array 222A and 222B can beadjusted at the granularity of each electrode. What is more, the centralpanel also allows the user to configure stimulating current at eachelectrode pair of the electrode array. For example, user interface 220may include control bars 223A and 223B, each representing an adjustablerange from 0.0 mA to 12.7 mA. In some instances, this adjustable rangecan be a continuum. In other instances, the adjustable range can includediscrete levels. In some of these instances, the discretely adjustablerange can be turned up or down through bars 224A and 224B respectivelyfor electrode arrays 222A and 222B.

In some implementations, other than allowing the user to configure thepolarity and current setting for each electrode or electrode pair onelectrode arrays 223A and 223B, user interface 220 allows the user tochoose from pre-existing programs 225, which may include program optionsI, II, and III, as well as polarity settings options I, II, and III.Each program option may include pre-set polarity settings for eachelectrode. Each program option can also include pre-set pulse parameterssuch as transmit power, pulse rate, and pulse width. Each polaritysettings option may include the polarity configuration for eachelectrode of the multi-electrode stimulator device. Transmission buttons226A and 226B allow information encoding a chosen setting to be sent tothe connected implantable device and effectuate the chosen setting.

The bottom panel of user interface 220 includes control bar 227 forconfiguring transmit power, control bar 228 for configuring pulse rate,and control bar 229 for controlling pulse width. As illustrated, thetransmit power can be configured within an adjustable range, forexample, from level 1 to level 24. Each level may represent a particularamount of transmit power with level 1 being the lowest and level 24being the highest power. The levels may be on a linear scale or alogarithmic scale. In some instances, the levels may range from 1 W to60 W. The transmit power may refer to the electric power beingtransmitted over a wireless connection from the controller device to theimplanted stimulator device, and may directly impact or result in thepulse amplitude applied at the electrodes. The pulse rate may beconfigured within an adjustable range from 0 Hz to 40 Hz. The pulsewidth may be configured within an adjustable range from 0 to 180 μs. Asillustrated, the adjustable ranges of transmit power, pulse rate, andpulse width can be configured in discrete steps. In other cases, theseparameters may be implemented on a continuum range. Some implementationsmay opt to have a configurable pulse amplitude representing the actualpulse amplitude being applied at a particular electrode. In suchimplementations, the pulse amplitude configuration option may beprovided in lieu of the transmit power configuration option (e.g., shownin control bar 227).

FIG. 2D shows example user interface 230 for the map view 126, which canbe used to capture user positioning information for the implantedstimulator device as a media file element. In this illustration, the toppanel of user interface 230 includes the same patient profileinformation 214. The captured user positioning information may be placedin any of up to four quadrants. In some implementations, the captureduser positioning information may include fluoroscopic image(s) of theimplantation site, for example, showing a radio-opaque implantablestimulator underneath the skin. In these implementations, thefluoroscopic image(s) may include a X-ray image that functions as areference image being presented in one of the four quadrants. In theseimplementations, the fluoroscopic image(s) may be taken by a clinician(e.g., a practicing nurse or caregiver) at a clinic. During anadjustment session, the user may take photos from a camera on, forexample, an iPad device. The photos may be presented in other quadrantsto provide visual guidance during placement of a MFS device relative tothe implanted stimulator device underneath the skin. In someimplementations, the user or the clinician may take a photo of the bodyarea where the implantable stimulator was placed within the body. Thephoto taken may be displayed at one of the quadrants, for example, as areference view. In these implementations, subsequent photos taken fromdifferent angles may be displayed at the remaining quadrants. Incombination with the reference view, these photos may allow the user toobtain a rather panoramic view of the body area where stimulationparameters are being adjusted. Similarly, subsequent photos may becompared to the reference view to allow the user to replicate camerapositioning or adjustment of parameters. Thus, the four illustratedquadrants may allow the user to take photos using, for example, an iPad,to quickly record important information and store such information.

In some instances, the photos of the implantation site are correlatedwith the fluoroscopic or other imaging technology image showing theimplanted stimulator device in the area of the implantation site. Inthese instances, the photos may represent a stereo view of theimplantation site to guide the placement of the controller device. Here,the correlation may provide navigational guidance as to an improvedpositioning of the MFS device for better coupling when establishing awireless connection between an MFS device and the implanted stimulatordevice.

FIG. 2E shows an example user interface 240 for the program view 128,which may be used by a user to set up a stimulation program on animplanted stimulator device. In this illustration, the top panel of userinterface 240 includes the same logout tab 218 and patient profileinformation 214. The top panel may also include a disconnect button 241to deactivate a wireless connection with an implanted stimulator device.The main panel of user interface 240 may include (i) pulse pattern panel242 to determine whether to set a pulse pattern for the stimulatingcurrents, (ii) dosage panel 244 to determine whether to use a timer totrack dosage, (iii) therapy panel 246 to set a lockout time inaccordance with configurable total therapy time, and (iv) program cyclepattern 248 to set up a treatment sequence. For context, a treatmentsequence is a concatenation of one or more programs of pulse patterns. Alockout time is a period above which the controller device will belocked so that no more stimulation may be accumulated.

FIG. 2F shows an example user interface 250 for the tools view 130,which displays tools for a user to configure stimulation parameters. Inthis illustration, the top panel of user interface 250 includes the samepatient profile information 214. The main tools panel includes a menuincluding menu option 252 for recording pain, a menu option 253 for userreporting, a menu option 254 for details of the wearable antennaassembly (WAA), a menu option 255 for Defaults, and a menu option 256for transfer settings. Menu option 252 allows a user to record painlevels during parameter adjustment to help the user determining animproved parameter setting. Menu option 253 allows a user to submitrecorded pain history as well as usage data showing how much and howoften the stimulator device has been used. Notably, menu option 252 mayrecord an adjustment in a configuration option made by the user thatresults in an improved quantitative index of pain. When recording theadjustment in the configuration option, adjustment in a pulse parameteror a polarity setting may be recorded. In particular, the recordedadjustment in the configuration option can be leveraged when generatinga recommended configuration setting. In other words, the at least onerecommended configuration option may be generated faster than otherwisein the absence of the recorded adjustment. The recorded adjustment mayincorporate the corresponding user-reported pain relief at thisconfiguration option. Menu option 255 allows a user to set defaultstimulation parameter for a connected stimulator device. Menu option 256allows a user to copy patient settings to another WAA. The WAA is theexternal transmitter unit that transmits power and instructions to theimplanted stimulators. In some implementations, the WAA is the MFSdevice that the programming unit communicates with. If the userinterchanges a WAA for a different serialized WAA unit, the applicationwill facilitate the transfer of the configurations from one WAA to thenext on request. As explained above in association with FIG. 1B, the WAAcan be an MFS device or a relay module.

FIG. 3 is a flow chart 300 for a user interface module to configurestimulation settings of the implanted simulator device. Initially,through a user interface (UI) interaction (302), a user announces anintent to change settings for a stimulation device (304). In someinstances, the announcement may be made by the configure button toinvoke a configuration user interface 220, as illustrated in FIG. 2C.Subsequently, the control program may impose safety limits (306). Insome instances, the safety limits may be a pre-determined thresholdamount and documented in the database 101. In some instances, the safetylimits may be determined based on a combination of polarity settings aswell as pulse parameters (including pulse rate, pulse width, andtransmit power). The safety limits may be determined by fuzzy logic orneural network based weighting algorithms to factor in various empiricaldata from past recorded data of patient experience. For example, a usermay be particularly sensitive to certain combination of polaritysettings and pulse parameters. Such combinations, or combinations closeto such combinations, may be avoided as a pre-caution. In theseinstances, neural network based weighting algorithm can providejudiciously chosen safety limits (e.g., on pulse rates) based on apatient's diagnosis and past experience.

If the parameter changes are deemed unsafe, the controller program maydisplay a warning message (310). In some instances, the warning messagemay include a pop-up window. In some instances, the warning message mayinclude an audio component, such as an alarm sound.

If the parameter changes are determined to be safe, the controllerprogram may proceed by transmitting changes to the MFS (314), which maycommunicate with the implanted stimulator device as appropriate. Thetransmitted data may be received by the MFS and, in a handshake manner,the MFS may transmit a confirmation message back to the externalcontroller. The confirmation message may be received and can serve as asuccess indication of the parameter transmit (316). In some instances,the external controller may ping the MFS for latest data encodingpolarity settings and pulse parameters (including pulse rate, pulsewidth, and transmit power) (318). Thereafter, the controller program mayupdate a display (312), for example, by showing an updated user profile214 to reflect the latest parameters obtained. The controller programmay also update the selectable safety values (320). In someimplementations, the selectable safety values may affect the choices forpulse pattern, dosage, and lockout time, as illustrated in FIG. 2E.

Some implementations can allow users to navigate the wider range ofchoices. As noted in FIG. 2C, the introduction of polarity settings atthe granularity of each electrode greatly expands the possibility of theconfiguration space. For example, there are 16 possible polaritysettings in addition to three continuum ranges for RF power/pulseamplitude, pulse rate, and pulse width. To navigate the user throughthis universe of configuration space, software algorithms areincorporated in these implementations to aid users in selectingconfigurations of the stimulation parameters. In particular, someimplementations record patient feedback for each particular combinationof polarity settings and pulse parameters. The recorded patient feedbackcan form an expert knowledge database to predict later configurations.The later configurations may apply to the same patient, or patients in acomparable group as classified by age, gender, target nerve or tissue,depth of implantation, or type of implanted stimulator devices. Forexample, a learning engine may be trained based on training data from agroup of users that includes, for example, stimulation parameters andresulting pain indexes as well as other variables such as patient age,patient gender, target nerve, anatomic orientation, depth′ ofimplantation, type of implanted stimulator devices, duration of therapy,and/or time of day. The trained learning engine may then suggest to agiven patient one or more initial stimulation parameters, such as pulseamplitude, pulse width, pulse rate, and/or polarity based on, forinstance, that given patient's age, gender, target nerve, depth ofimplantation, type of implanted stimulator devices, duration of therapy,time of day, and/or non-suggested stimulation parameters. As that givenpatient conducts therapy, the patient may provide feedback about his orher pain and adjust the stimulation parameters, and the learning enginemay develop a profile specific that to that user and provide suggestedstimulation parameters for future sessions.

FIGS. 4A and 4B show example software decision trees 400A and 400B toauto-adjust therapy settings based on user recorded pain. In 400A,initially, a user may select an interface to record his/her current painintensity (402). The selection may be through, for example, menu option252 at example user interface 250. When the selection is made, the usermay then record their pain level. For the purpose of running through thetwo auto-configurations, the state of ‘off’ has no effect on thealgorithm of auto-adjustment. Thus recording can be made when theimplanted stimulator device is “on” or “off” (404). When the stimulatordevice is “on,” a first determination is made regarding whether the painlevel is greater than 5 or medium (406). In some instances, thedetermination is based on user input.

If the pain level is greater than 5 or medium, a determination is maderegarding whether to improve therapy (414). In one branch, the user mayindicate whether the user may want to improve therapy (414) by changingpulse parameters or polarity settings. If the user does not wish toimprove therapy, the process may conclude (418). If the user's desire isto improve therapy, then the process begins cycling through theparameters to be adjusted (422A). In one branch, the process may adjustpolarity configurations in an effort to fine tune the effect ofstimulation (428). The adjustment may be initiated from a recommendationthat is derived based on a knowledge database/learning engine 427. Forexample, the suggested polarity configuration can be determined by theknowledge database/learning engine 427 based on parameters such aspatient's age, gender, target nerve, depth of implantation, type ofimplanted stimulator device, duration of therapy, time of day,non-suggested stimulation parameters, and/or historical stimulationparameters and resulting pain.

In yet another branch, the process may proceed to set pulse rate to alevel (426). In still yet another branch, the process may proceed to setpulse width to a level (420). In another branch, the process mayincrease pulse amplitude by a particular amount (424). The amount mayscale with the reported pain level, for example, in the amount of PainLevel×0.05. In these latter branches, the pulse rate or pulse width maybe randomly selected from a sub-range of values from the full range ofthe values. The subrange may be selected by the knowledgedatabase/learning engine 427 based on parameters such as patient's age,gender, target nerve, depth of implantation, type of implantedstimulator device, duration of therapy, time of day, non-suggestedstimulation parameters, and/or historical stimulation parameters andresulting pain. By randomly selecting values for pulse width and pulserate, the patient is more likely to notice a difference in treatmentthan if values for these parameters were sequentially changed.

After a given one of the stimulation parameters are adjusted, adetermination is made as to whether therapy was improved (430). If theuser indicates that the therapy has improved, the process may loop backto ask the user to record pain relief (404). If the user indicates thatthe therapy has not improved, or no user feedback is received within 3seconds, the process may cycle to next parameter adjustment (434). Forexample, the process may cycle from pulse width adjustment to pulse rateadjustment (or vice versa). In this manner, the process 400A adjusts oneparameter sequentially at a time, asking the patient if therapy hasimproved after each adjustment. If not, or after a short period of time,the process updates the next parameter and again asks the patient iftherapy has improved.

The determination (430) also provides a third option for the user tochoose—the reset. If chosen, the program may enter the reset branch inwhich stimulation parameters, including polarity settings, are reset tooriginal state before adjustments (432). The reset branch reverts thestimulation configurations (including pulse parameters and electrodepolarity settings) back to the original state prior to user adjustment.

When the user has already selected a therapy program and has receivedpain relief from the therapy program, a pop-up window may be displayedto ask the user if the user wants to decrease pulse amplitude (408) if,for example, the pain level is not greater than, for example, 5 ormedium. In some cases, the user may receive relief from the treatment,but the treatment may be uncomfortable if the pulse amplitude is high.If the user does not want to decrease the amplitude, the decision treemay conclude (410). If the user indicates that the user wants todecrease the pulse amplitude, the process 400A decreases pulse amplitudeas executed on the implanted stimulator device by a certain amount(e.g., by 0.3 mA) (416). A determination is then made regarding iftherapy is still providing sufficient pain relief even at the decreasedpulse amplitude such that the user may keep the adjusted pulseamplitude, discard the adjusted pulse amplitude, or further adjust thepulse amplitude (438). If the therapy is still providing sufficient painrelief and the patient is no longer uncomfortable (or otherwise decidesthat the current pulse amplitude is satisfactory), the user may decideto keep the adjusted pulse amplitude and process 400A may conclude(410). When the therapy is still providing sufficient pain relief andthe user still wishes to refine the pulse amplitude (or the adjustedpulse amplitude remains an uncomfortable choice), the decreased pulseamplitude may be further adjusted (416). If the therapy is no longerproviding sufficient pain relief, the user may decide to revert thepulse amplitude to the previously set amplitude and the process 400A maydo so (440) before concluding the adjustment (410).

Process 400B, as depicted in FIG. 4B, largely tracks process 400A fromFIG. 4A. The main difference between process 400A and 400B is that whenthe user indicates that the user would like to improve therapy, the useris asked which parameter to adjust and then the process continues toadjust just that parameter. Accordingly, if the user's desire is toimprove therapy, then the user is prompted to select a parameter toadjust (422B). For example, the user can select the pulse width, pulserate, pulse amplitude, or polarity. The selected parameter is thenadjusted (420, 426, 428, or 424), for example, in the manner describedwith respect to FIG. 4A and the user is asked if therapy is improved(430). If not, then the selected parameter is adjusted until the userdecides therapy has improved (434). The other actions of process 400Boccur as described with respect to the corresponding actions in process400A.

FIG. 5 depicts a detailed diagram 500 of an example of a neuralstimulation system including programming module 560, RF pulse generatormodule 570, and implantable neural stimulator module 580. Programmingmodule 560 and RF pulse generator module 570 may respectively correspondto the mobile computing device and MFS discussed above in associationwith FIG. 1. Implantable neural stimulator module 580 may correspond tothe implanted stimulator device discussed above in association with FIG.1.

As depicted, the programming module 560 may comprise user input system502 and communication subsystem 508. The user input system 521 may allowvarious parameter settings to be adjusted (in some cases, in an openloop fashion) by the user in the form of instruction sets. Thecommunication subsystem 508 may transmit these instruction sets (andother information) via the wireless connection 564, such as Bluetooth orWi-Fi, to the RF pulse generator module 570, as well as receive datafrom module 570.

For instance, the programmer module 560, which can be utilized formultiple users, such as a patient's control unit or clinician'sprogrammer unit, can be used to send stimulation parameters to the RFpulse generator module 560. The stimulation parameters that can becontrolled may include pulse amplitude, pulse frequency, and pulse widthin the ranges shown in Table 1. In this context the term pulse refers tothe phase of the waveform that directly produces stimulation of thetissue; the parameters of the charge-balancing phase (described below)can similarly be controlled. The patient and/or the clinician can alsooptionally control overall duration and pattern of treatment.

Stimulation Parameter Table 1

Pulse Amplitude: 0 to 20 mA

Pulse Frequency: 0 to 2000 Hz

Pulse Width: 0 to 2 ms

The implantable neural stimulator module 580 or RF pulse generatormodule 570 may be initially programmed to meet the specific parametersettings for each individual patient during the initial implantationprocedure. Because medical conditions or the body itself can change overtime, the ability to re-adjust the parameter settings may be beneficialto ensure ongoing efficacy of the neural modulation therapy.

The programmer module 560 may be functionally a smart device andassociated application. The smart device hardware may include a CPU 506and be used as a vehicle to handle touchscreen input on a graphical userinterface (GUI) 504, for processing and storing data.

The RF pulse generator module 506 may be connected via wired connection578 to an external TX antenna 510. Alternatively, both the antenna andthe RF pulse generator are located subcutaneously (not shown).

The signals sent by RF pulse generator module 570 to the implantedstimulator module 580 may include both power and parameter-settingattributes in regards to stimulus waveform, amplitude, pulse width, andfrequency. The RF pulse generator module 570 can also function as awireless receiving unit that receives feedback signals from theimplanted stimulator module 580. To that end, the RF pulse generatormodule 570 may contain microelectronics or other circuitry to handle thegeneration of the signals transmitted to the implanted stimulator module580 as well as handle feedback signals, such as those from the implantedstimulator module 580. For example, the RF pulse generator module 570may comprise controller subsystem 514, high-frequency oscillator 518, RFamplifier 516, a RF switch, and a feedback subsystem 512.

The controller subsystem 514 may include a CPU 530 to handle dataprocessing, a memory subsystem 528 such as a local memory, communicationsubsystem 534 to communicate with programmer module 560 (includingreceiving stimulation parameters from programmer module), pulsegenerator circuitry 570, and digital/analog (D/A) converters 532.

The controller subsystem 514 may be used by the patient and/or theclinician to control the stimulation parameter settings (for example, bycontrolling the parameters of the signal sent from RF pulse generatormodule 570 to neural stimulator module 580). These parameter settingscan affect, for example, the power, current level, or shape of the oneor more electrical pulses. The programming of the stimulation parameterscan be performed using the programming module 560, as described above,to set the repetition rate, pulse width, amplitude, and waveform thatwill be transmitted by RF energy to the receive (RX) antenna 538,typically a dipole antenna (although other types may be used), in thewireless implanted neural stimulator module 514. The clinician may havethe option of locking and/or hiding certain settings within theprogrammer interface, thus limiting the patient's ability to view oradjust certain parameters because adjustment of certain parameters mayrequire detailed medical knowledge of neurophysiology, neuroanatomy,protocols for neural modulation, and safety limits of electricalstimulation.

The controller subsystem 514 may store received parameter settings inthe local memory subsystem 528, until the parameter settings aremodified by new input data received from the programming module 560. TheCPU 506 may use the parameters stored in the local memory to control thepulse generator circuitry 536 to generate a stimulus waveform that ismodulated by a high frequency oscillator 518 in the range from 300 MHzto 8 GHz. The resulting RF signal may then be amplified by RF amplifier526 and then sent through an RF switch 523 to the TX antenna 581 toreach through depths of tissue to the RX antenna 538.

In some implementations, the RF signal sent by TX antenna 581 may simplybe a power transmission signal used by stimulator module 580 to generateelectric pulses. In other implementations, a telemetry signal may alsobe transmitted to the stimulator module 580 to send instructions aboutthe various operations of the stimulator module 580. The telemetrysignal may be sent by the modulation of the carrier signal (through theskin if external, or through other body tissues if the pulse generatormodule 570 is implanted subcutaneously). The telemetry signal is used tomodulate the carrier signal (a high frequency signal) that is coupledonto the implanted antenna(s) 538 and does not interfere with the inputreceived on the same stimulator to power the implant. In one embodimentthe telemetry signal and powering signal are combined into one signal,where the RF telemetry signal is used to modulate the RF poweringsignal, and thus the implanted stimulator is powered directly by thereceived telemetry signal; separate subsystems in the stimulator harnessthe power contained in the signal and interpret the data content of thesignal.

The RF switch 523 may be a multipurpose device such as a dualdirectional coupler, which passes the relatively high amplitude,extremely short duration RF pulse to the TX antenna 581 with minimalinsertion loss while simultaneously providing two low-level outputs tofeedback subsystem 512; one output delivers a forward power signal tothe feedback subsystem 512, where the forward power signal is anattenuated version of the RF pulse sent to the TX antenna 581, and theother output delivers a reverse power signal to a different port of thefeedback subsystem 512, where reverse power is an attenuated version ofthe reflected RF energy from the TX Antenna 581.

During the on-cycle time (when an RF signal is being transmitted tostimulator 580), the RF switch 523 is set to send the forward powersignal to feedback subsystem. During the off-cycle time (when an RFsignal is not being transmitted to the stimulator module 580), the RFswitch 523 can change to a receiving mode in which the reflected RFenergy and/or RF signals from the stimulator module 580 are received tobe analyzed in the feedback subsystem 512.

The feedback subsystem 512 of the RF pulse generator module 570 mayinclude reception circuitry to receive and extract telemetry or otherfeedback signals from the stimulator 580 and/or reflected RF energy fromthe signal sent by TX antenna 581. The feedback subsystem may include anamplifier 526, a filter 524, a demodulator 522, and an A/D converter520.

The feedback subsystem 512 receives the forward power signal andconverts this high-frequency AC signal to a DC level that can be sampledand sent to the controller subsystem 514. In this way thecharacteristics of the generated RF pulse can be compared to a referencesignal within the controller subsystem 514. If a disparity (error)exists in any parameter, the controller subsystem 514 can adjust theoutput to the RF pulse generator 570. The nature of the adjustment canbe, for example, proportional to the computed error. The controllersubsystem 514 can incorporate additional inputs and limits on itsadjustment scheme such as the signal amplitude of the reverse power andany predetermined maximum or minimum values for various pulseparameters.

The reverse power signal can be used to detect fault conditions in theRF-power delivery system. In an ideal condition, when TX antenna 581 hasperfectly matched impedance to the tissue that it contacts, theelectromagnetic waves generated from the RF pulse generator 570 passunimpeded from the TX antenna 581 into the body tissue. However, inreal-world applications a large degree of variability may exist in thebody types of users, types of clothing worn, and positioning of theantenna 581 relative to the body surface. Since the impedance of theantenna 581 depends on the relative permittivity of the underlyingtissue and any intervening materials, and also depends on the overallseparation distance of the antenna from the skin, in any givenapplication there can be an impedance mismatch at the interface of theTX antenna 581 with the body surface. When such a mismatch occurs, theelectromagnetic waves sent from the RF pulse generator 570 are partiallyreflected at this interface, and this reflected energy propagatesbackward through the antenna feed.

The dual directional coupler RF switch 523 may prevent the reflected RFenergy propagating back into the amplifier 526, and may attenuate thisreflected RF signal and send the attenuated signal as the reverse powersignal to the feedback subsystem 512. The feedback subsystem 512 canconvert this high-frequency AC signal to a DC level that can be sampledand sent to the controller subsystem 514. The controller subsystem 514can then calculate the ratio of the amplitude of the reverse powersignal to the amplitude of the forward power signal. The ratio of theamplitude of reverse power signal to the amplitude level of forwardpower may indicate severity of the impedance mismatch.

In order to sense impedance mismatch conditions, the controllersubsystem 514 can measure the reflected-power ratio in real time, andaccording to preset thresholds for this measurement, the controllersubsystem 514 can modify the level of RF power generated by the RF pulsegenerator 570. For example, for a moderate degree of reflected power thecourse of action can be for the controller subsystem 514 to increase theamplitude of RF power sent to the TX antenna 581, as would be needed tocompensate for slightly non-optimum but acceptable TX antenna couplingto the body. For higher ratios of reflected power, the course of actioncan be to prevent operation of the RF pulse generator 570 and set afault code to indicate that the TX antenna 581 has little or no couplingwith the body. This type of reflected-power fault condition can also begenerated by a poor or broken connection to the TX antenna. In eithercase, it may be desirable to stop RF transmission when thereflected-power ratio is above a defined threshold, because internallyreflected power can result in unwanted heating of internal components,and this fault condition means the system cannot deliver sufficientpower to the implanted wireless neural stimulator and thus cannotdeliver therapy to the user.

The controller 542 of the stimulator 580 may transmit informationalsignals, such as a telemetry signal, through the antenna 538 tocommunicate with the RF pulse generator module 570 during its receivecycle. For example, the telemetry signal from the stimulator 580 may becoupled to the modulated signal on the dipole antenna(s) 538, during theon and off state of the transistor circuit to enable or disable awaveform that produces the corresponding RF bursts necessary to transmitto the external (or remotely implanted) pulse generator module 570. Theantenna(s) 538 may be connected to electrodes 554 in contact with tissueto provide a return path for the transmitted signal. An A/D (not shown)converter can be used to transfer stored data to a serialized patternthat can be transmitted on the pulse modulated signal from the internalantenna(s) 538 of the neural stimulator.

A telemetry signal from the implanted wireless neural stimulator module580 may include stimulus parameters such as the power or the amplitudeof the current that is delivered to the tissue from the electrodes. Thefeedback signal can be transmitted to the RF pulse generator module 570to indicate the strength of the stimulus at the nerve bundle by means ofcoupling the signal to the implanted RX antenna 538, which radiates thetelemetry signal to the external (or remotely implanted) RF pulsegenerator module 570. The feedback signal can include either or both ananalog and digital telemetry pulse modulated carrier signal. Data suchas stimulation pulse parameters and measured characteristics ofstimulator performance can be stored in an internal memory device withinthe implanted neural stimulator 580, and sent on the telemetry signal.The frequency of the carrier signal may be in the range of at 300 MHz to8 GHz.

In the feedback subsystem 512, the telemetry signal can be downmodulated using demodulator 522 and digitized by being processed throughan analog to digital (A/D) converter 520. The digital telemetry signalmay then be routed to a CPU 530 with embedded code, with the option toreprogram, to translate the signal into a corresponding currentmeasurement in the tissue based on the amplitude of the received signal.The CPU 530 of the controller subsystem 514 can compare the reportedstimulus parameters to those held in local memory 528 to verify thestimulator(s) 580 delivered the specified stimuli to tissue. Forexample, if the stimulator reports a lower current than was specified,the power level from the RF pulse generator module 570 can be increasedso that the implanted neural stimulator 580 will have more availablepower for stimulation. The implanted neural stimulator 580 can generatetelemetry data in real time, for example, at a rate of 8 kbits persecond. All feedback data received from the implanted stimulator module580 can be logged against time and sampled to be stored for retrieval toa remote monitoring system accessible by the health care professionalfor trending and statistical correlations.

The sequence of remotely programmable RF signals received by theinternal antenna(s) 538 may be conditioned into waveforms that arecontrolled within the implantable stimulator 580 by the controlsubsystem 542 and routed to the appropriate electrodes 554 that areplaced in proximity to the tissue to be stimulated. For instance, the RFsignal transmitted from the RF pulse generator module 570 may bereceived by RX antenna 538 and processed by circuitry, such as waveformconditioning circuitry 540, within the implanted wireless neuralstimulator module 580 to be converted into electrical pulses applied tothe electrodes 554 through electrode interface 552. In someimplementations, the implanted stimulator 580 contains between two tosixteen electrodes 554.

The waveform conditioning circuitry 540 may include a rectifier 544,which rectifies the signal received by the RX antenna 538. The rectifiedsignal may be fed to the controller 542 for receiving encodedinstructions from the RF pulse generator module 570. The rectifiersignal may also be fed to a charge balance component 546 that isconfigured to create one or more electrical pulses based such that theone or more electrical pulses result in a substantially zero net chargeat the one or more electrodes (that is, the pulses are charge balanced).The charge-balanced pulses are passed through the current limiter 548 tothe electrode interface 552, which applies the pulses to the electrodes554 as appropriate.

The current limiter 548 insures the current level of the pulses appliedto the electrodes 554 is not above a threshold current level. In someimplementations, an amplitude (for example, current level, voltagelevel, or power level) of the received RF pulse directly determines theamplitude of the stimulus. In this case, it may be particularlybeneficial to include current limiter 548 to prevent excessive currentor charge being delivered through the electrodes, although currentlimiter 548 may be used in other implementations where this is not thecase. Generally, for a given electrode having several square millimeterssurface area, it is the charge per phase that should be limited forsafety (where the charge delivered by a stimulus phase is the integralof the current). But, in some cases, the limit can instead be placed onthe current, where the maximum current multiplied by the maximumpossible pulse duration is less than or equal to the maximum safecharge. More generally, the limiter 548 acts as a charge limiter thatlimits a characteristic (for example, current or duration) of theelectrical pulses so that the charge per phase remains below a thresholdlevel (typically, a safe-charge limit).

In the event the implanted wireless neural stimulator 580 receives a“strong” pulse of RF power sufficient to generate a stimulus that wouldexceed the predetermined safe-charge limit, the current limiter 548 canautomatically limit or “clip” the stimulus phase to maintain the totalcharge of the phase within the safety limit. The current limiter 548 maybe a passive current limiting component that cuts the signal to theelectrodes 554 once the safe current limit (the threshold current level)is reached. Alternatively, or additionally, the current limiter 548 maycommunicate with the electrode interface 552 to turn off all electrodes554 to prevent tissue damaging current levels.

A clipping event may trigger a current limiter feedback control mode.The action of clipping may cause the controller to send a thresholdpower data signal to the pulse generator 570. The feedback subsystem 512detects the threshold power signal and demodulates the signal into datathat is communicated to the controller subsystem 514. The controllersubsystem 514 algorithms may act on this current-limiting condition byspecifically reducing the RF power generated by the RF pulse generator,or cutting the power completely. In this way, the pulse generator 570can reduce the RF power delivered to the body if the implanted wirelessneural stimulator 580 reports it is receiving excess RF power.

The controller 550 of the stimulator 580 may communicate with theelectrode interface 552 to control various aspects of the electrodesetup and pulses applied to the electrodes 554. The electrode interface552 may act as a multiplex and control the polarity and switching ofeach of the electrodes 554. For instance, in some implementations, thewireless stimulator 570 has multiple electrodes 554 in contact withtissue, and for a given stimulus the RF pulse generator module 570 canarbitrarily assign one or more electrodes to 1) act as a stimulatingelectrode, 2) act as a return electrode, or 3) be inactive bycommunication of assignment sent wirelessly with the parameterinstructions, which the controller 550 uses to set electrode interface552 as appropriate. It may be physiologically advantageous to assign,for example, one or two electrodes as stimulating electrodes and toassign all remaining electrodes as return electrodes.

Also, in some implementations, for a given stimulus pulse, thecontroller 550 may control the electrode interface 552 to divide thecurrent arbitrarily (or according to instructions from pulse generatormodule 570) among the designated stimulating electrodes. This controlover electrode assignment and current control can be advantageousbecause in practice the electrodes 554 may be spatially distributedalong various neural structures, and through strategic selection of thestimulating electrode location and the proportion of current specifiedfor each location, the aggregate current distribution in tissue can bemodified to selectively activate specific neural targets. This strategyof current steering can improve the therapeutic effect for the patient.

In another implementation, the time course of stimuli may be arbitrarilymanipulated. A given stimulus waveform may be initiated at a timeT_start and terminated at a time T_final, and this time course may besynchronized across all stimulating and return electrodes; further, thefrequency of repetition of this stimulus cycle may be synchronous forall the electrodes. However, controller 550, on its own or in responseto instructions from pulse generator 570, can control electrodeinterface 552 to designate one or more subsets of electrodes to deliverstimulus waveforms with non-synchronous start and stop times, and thefrequency of repetition of each stimulus cycle can be arbitrarily andindependently specified.

For example, a stimulator having eight electrodes may be configured tohave a subset of five electrodes, called set A, and a subset of threeelectrodes, called set B. Set A might be configured to use two of itselectrodes as stimulating electrodes, with the remainder being returnelectrodes. Set B might be configured to have just one stimulatingelectrode. The controller 550 could then specify that set A deliver astimulus phase with 3 mA current for a duration of 200 us followed by a400 us charge-balancing phase. This stimulus cycle could be specified torepeat at a rate of 60 cycles per second. Then, for set B, thecontroller 550 could specify a stimulus phase with 1 mA current forduration of 500 us followed by a 800 us charge-balancing phase. Therepetition rate for the set-B stimulus cycle can be set independently ofset A, say for example it could be specified at 25 cycles per second.Or, if the controller 550 was configured to match the repetition ratefor set B to that of set A, for such a case the controller 550 canspecify the relative start times of the stimulus cycles to be coincidentin time or to be arbitrarily offset from one another by some delayinterval.

In some implementations, the controller 550 can arbitrarily shape thestimulus waveform amplitude, and may do so in response to instructionsfrom pulse generator 570. The stimulus phase may be delivered by aconstant-current source or a constant-voltage source, and this type ofcontrol may generate characteristic waveforms that are static, e.g. aconstant-current source generates a characteristic rectangular pulse inwhich the current waveform has a very steep rise, a constant amplitudefor the duration of the stimulus, and then a very steep return tobaseline. Alternatively, or additionally, the controller 550 canincrease or decrease the level of current at any time during thestimulus phase and/or during the charge-balancing phase. Thus, in someimplementations, the controller 550 can deliver arbitrarily shapedstimulus waveforms such as a triangular pulse, sinusoidal pulse, orGaussian pulse for example. Similarly, the charge-balancing phase can bearbitrarily amplitude-shaped, and similarly an anodic pulse (prior tothe stimulus phase) may also be amplitude-shaped.

As described above, the stimulator 580 may include a charge-balancingcomponent 546. Generally, for constant current stimulation pulses,pulses should be charge balanced by having the amount of cathodiccurrent should equal the amount of anodic current, which is typicallycalled biphasic stimulation. Charge density is the amount of currenttimes the duration it is applied, and is typically expressed in theunits uC/cm2. In order to avoid the irreversible electrochemicalreactions such as pH change, electrode dissolution as well as tissuedestruction, no net charge should appear at the electrode-electrolyteinterface, and it is generally acceptable to have a charge density lessthan 30 uC/cm2. Biphasic stimulating current pulses ensure that no netcharge appears at the electrode after each stimulation cycle and theelectrochemical processes are balanced to prevent net dc currents.Neural stimulator 580 may be designed to ensure that the resultingstimulus waveform has a net zero charge. Charge balanced stimuli arethought to have minimal damaging effects on tissue by reducing oreliminating electrochemical reaction products created at theelectrode-tissue interface.

A stimulus pulse may have a negative-voltage or current, called thecathodic phase of the waveform. Stimulating electrodes may have bothcathodic and anodic phases at different times during the stimulus cycle.An electrode that delivers a negative current with sufficient amplitudeto stimulate adjacent neural tissue is called a “stimulating electrode.”During the stimulus phase the stimulating electrode acts as a currentsink. One or more additional electrodes act as a current source andthese electrodes are called “return electrodes.” Return electrodes areplaced elsewhere in the tissue at some distance from the stimulatingelectrodes. When a typical negative stimulus phase is delivered totissue at the stimulating electrode, the return electrode has a positivestimulus phase. During the subsequent charge-balancing phase, thepolarities of each electrode are reversed.

In some implementations, the charge balance component 546 uses ablocking capacitor(s) placed electrically in series with the stimulatingelectrodes and body tissue, between the point of stimulus generationwithin the stimulator circuitry and the point of stimulus delivery totissue. In this manner, a resistor-capacitor (RC) network may be formed.In a multi-electrode stimulator, one charge-balance capacitor(s) may beused for each electrode or a centralized capacitor(s) may be used withinthe stimulator circuitry prior to the point of electrode selection. TheRC network can block direct current (DC), however it can also preventlow-frequency alternating current (AC) from passing to the tissue. Thefrequency below which the series RC network essentially blocks signalsis commonly referred to as the cutoff frequency, and in one embodimentthe design of the stimulator system may ensure the cutoff frequency isnot above the fundamental frequency of the stimulus waveform. In thisembodiment, the wireless stimulator may have a charge-balance capacitorwith a value chosen according to the measured series resistance of theelectrodes and the tissue environment in which the stimulator isimplanted. By selecting a specific capacitance value the cutofffrequency of the RC network in this embodiment is at or below thefundamental frequency of the stimulus pulse.

In other implementations, the cutoff frequency may be chosen to be at orabove the fundamental frequency of the stimulus, and in this scenariothe stimulus waveform created prior to the charge-balance capacitor,called the drive waveform, may be designed to be non-stationary, wherethe envelope of the drive waveform is varied during the duration of thedrive pulse. For example, in one embodiment, the initial amplitude ofthe drive waveform is set at an initial amplitude Vi, and the amplitudeis increased during the duration of the pulse until it reaches a finalvalue k*Vi. By changing the amplitude of the drive waveform over time,the shape of the stimulus waveform passed through the charge-balancecapacitor is also modified. The shape of the stimulus waveform may bemodified in this fashion to create a physiologically advantageousstimulus.

In some implementations, the wireless neural stimulator module 580 maycreate a drive-waveform envelope that follows the envelope of the RFpulse received by the receiving dipole antenna(s) 538. In this case, theRF pulse generator module 570 can directly control the envelope of thedrive waveform within the wireless neural stimulator 580, and thus noenergy storage may be required inside the stimulator itself. In thisimplementation, the stimulator circuitry may modify the envelope of thedrive waveform or may pass it directly to the charge-balance capacitorand/or electrode-selection stage.

In some implementations, the implanted neural stimulator 580 may delivera single-phase drive waveform to the charge balance capacitor or it maydeliver multiphase drive waveforms. In the case of a single-phase drivewaveform, for example, a negative-going rectangular pulse, this pulsecomprises the physiological stimulus phase, and the charge-balancecapacitor is polarized (charged) during this phase. After the drivepulse is completed, the charge balancing function is performed solely bythe passive discharge of the charge-balance capacitor, where isdissipates its charge through the tissue in an opposite polarityrelative to the preceding stimulus. In one implementation, a resistorwithin the stimulator facilitates the discharge of the charge-balancecapacitor. In some implementations, using a passive discharge phase, thecapacitor may allow virtually complete discharge prior to the onset ofthe subsequent stimulus pulse.

In the case of multiphase drive waveforms the wireless stimulator mayperform internal switching to pass negative-going or positive-goingpulses (phases) to the charge-balance capacitor. These pulses may bedelivered in any sequence and with varying amplitudes and waveformshapes to achieve a desired physiological effect. For example, thestimulus phase may be followed by an actively driven charge-balancingphase, and/or the stimulus phase may be preceded by an opposite phase.Preceding the stimulus with an opposite-polarity phase, for example, canhave the advantage of reducing the amplitude of the stimulus phaserequired to excite tissue.

In some implementations, the amplitude and timing of stimulus andcharge-balancing phases is controlled by the amplitude and timing of RFpulses from the RF pulse generator module 570, and in others thiscontrol may be administered internally by circuitry onboard the wirelessstimulator 580, such as controller 550. In the case of onboard control,the amplitude and timing may be specified or modified by data commandsdelivered from the pulse generator module 570.

Modulation of excitable tissue in the body by electrical stimulation hasbecome an important type of therapy for patients with chronic disablingconditions, including chronic pain, problems of movement initiation andcontrol, involuntary movements, vascular insufficiency, heartarrhythmias and more. A variety of therapeutic intra-body electricalstimulation techniques can treat these conditions. For instance, devicesmay be used to deliver stimulatory signals to excitable tissue, recordvital signs, perform pacing or defibrillation operations, record actionpotential activity from targeted tissue, control drug release fromtime-release capsules or drug pump units, or interface with the auditorysystem to assist with hearing.

A number of implementations have been described. Nevertheless, it willbe understood that various modifications may be made. Accordingly, otherimplementations are within the scope of the following claims.

What is claimed is:
 1. A computer-assisted method to configure settings on an implanted stimulator device, the method comprising: presenting configuration options to a user of the implanted stimulator device, the configuration options comprising stimulation parameters for the implanted stimulator, the stimulation parameters comprising polarity setting such that presenting configuration options to the user of the implanted stimulator device comprises presenting configuration options that include a polarity setting of each electrode of the implanted stimulator device; receiving a user specification of the configuration options in response to the presented configuration options; receiving user feedback when the user specified configuration options are implemented at the implanted stimulator device, the user feedback comprising a quantitative index of pain resulting from implementing the user specified configuration options on the implanted stimulator device; building a user profile for the user based on the user specified configuration options and the user feedback, the user profile including the user specified configuration options as well as the corresponding quantitative index of pain; and selecting at least one configuration option based on the user profile when the configuration options are subsequently presented to the user for a later treatment.
 2. The method of claim 1, wherein building a user profile for the user comprises building a user profile that includes the polarity setting of each electrode that gives rise to the corresponding quantitative index of pain.
 3. The method of claim 2, wherein selecting at least one configuration option further comprises selecting a polarity setting for at least one of the electrodes of the implanted stimulator device.
 4. The method of claim 1, wherein the stimulation parameters comprise pulse rate, pulse width, and pulse amplitude such that presenting configuration options comprises presenting configuration options that that include pulse rate, pulse width, and pulse amplitude.
 5. The method of claim 4, further comprising: in response to determining that the quantitative index of pain is above a threshold level, prompting the user to change the configuration options.
 6. The method of claim 5, wherein prompting the user to change the configuration options comprises presenting at least one configuration option based on the user profile.
 7. The method of claim 6, further comprising: increasing, by an amount that is proportional to the quantitative index of pain, a pulse amplitude of stimulation pulses for application at a particular electrode.
 8. The method of claim 4, further comprising: in response to determining that the quantitative index of pain is below a threshold level, prompting the user to reduce stimulation.
 9. The method of claim 8, wherein prompting the user to reduce stimulation comprises prompting the user to reduce stimulation by decreasing a pulse amplitude of stimulation pulses for application at a particular electrode.
 10. The method of claim 1, wherein presenting configuration options further comprises cycling through the each configuration option subject to user adjustment, the configuration options including the polarity setting of each electrode of the implanted stimulator device as well as pulse parameters of stimulation pulses for application at a particular electrode.
 11. The method of claim 1, wherein building a user profile further comprises recording an adjustment in a configuration option made by the user that results in an improved quantitative index of pain.
 12. The method of claim 11, wherein recording the adjustment in the configuration option includes recording an adjustment in a pulse parameter or a polarity setting.
 13. A controller device to configure settings on an implanted stimulator device, the controller device comprising a processor configured to perform the operations of: presenting configuration options to a user of the implanted stimulator device, the configuration options comprising stimulation parameters for the implanted stimulator, the stimulation parameters comprising polarity setting such that presenting configuration options to the user of the implanted stimulator device comprises presenting configuration options that include a polarity setting of each electrode of the implanted stimulator device; receiving a user specification of the configuration options in response to the presented configuration options; receiving user feedback when the user specified configuration options are implemented at the implanted stimulator device, the user feedback comprising a quantitative index of pain resulting from implementing the user specified configuration options on the implanted stimulator device; building a user profile for the user based on the user specified configuration options and the user feedback, the user profile including the user specified configuration options as well as the corresponding quantitative index of pain; and selecting at least one configuration option based on the user profile when the configuration options are subsequently presented to the user for a later treatment.
 14. The controller device of claim 13, wherein building a user profile for the user comprises building a user profile that includes the polarity setting of each electrode that gives rise to the corresponding quantitative index of pain.
 15. The controller device of claim 14, wherein selecting at least one configuration option further comprises selecting a polarity setting for at least one of the electrodes of the implanted stimulator device.
 16. The controller device of claim 13, wherein the stimulation parameters comprise pulse rate, pulse width, and pulse amplitude such that presenting configuration options comprises presenting configuration options that that include pulse rate, pulse width, and pulse amplitude.
 17. The controller device of claim 13, wherein the operations further comprise: in response to determining that the quantitative index of pain is above a threshold level, prompting the user to change the configuration options.
 18. The controller device of claim 13, wherein the operations further comprise: further comprising in response to determining that the quantitative index of pain is below a threshold level, prompting the user to reduce stimulation. 